Isotopic synovectomy with P-32 in paediatric patients with haemophilia

Citation
P. Mathew et al., Isotopic synovectomy with P-32 in paediatric patients with haemophilia, HAEMOPHILIA, 6(5), 2000, pp. 547-555
Citations number
25
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Hematology
Journal title
HAEMOPHILIA
ISSN journal
1351-8216 → ACNP
Volume
6
Issue
5
Year of publication
2000
Pages
547 - 555
Database
ISI
SICI code
1351-8216(200009)6:5<547:ISWPIP>2.0.ZU;2-U
Abstract
Isotopic synovectomy is being proposed as an option in the treatment of pat ients with haemophilic arthropathy. We present our experience with 11 paedi atric patients who underwent 17, P-32 isotopic synovectomies for chronic ha emophilic arthropathy. P-32 was injected into the joint per protocol, appro ved by the institutional review board. All our patients were male. Nine wer e factor VIII and two were factor IX deficient. The following joints were t reated: ankle (n = 10 procedures), elbow (n = 5) and knee (n = 2). The firs t procedure was performed on December 1993. None were human immunodeficienc y virus positive. Mean age at the first procedure was 10.8 years (range, 5. 2-15.2 years). Mean pretreatment joint clinical scores using the World Fede ration of Hemophilia guidelines for the ankle was 5.5 (SD +/- 2.3), the elb ow 4.2 (+/- 2.5), and knee 5.5 (+/- 3.5); the corresponding post-treatment scores were 2.6 (+/- 2.0), 1.4 (+/- 0.5) and 2.5 (+/- 3.5) respectively. Pr esynovectomy mean radiological scores using the Pettersson method were: ank le 1.8, elbow 1.8, and knee 1.5. A scoring system used in our centre for ev aluating joints using magnetic resonance imaging (MRI) gave the following m ean pretreatment scores: ankle 9.5, elbow 8.4, and knee 5.0. A marked decre ase (an 80-100% decrease) in bleeding was seen in 13 of 17 procedures, and a moderate decrease (51-79% decrease) in two procedures, accounting for 85% reduction in bleeding into the target joints. The procedure was well toler ated and no untoward side-effects were noted as of May 1999, with a median follow-up of 40 months (range 19-65 months). None had any clinical evidence of cancer. Three patients had their joints retreated [elbow (one), ankle ( two)]. These procedures were also well tolerated. In conclusion, in our stu dy, isotopic synovectomy using P-32 appears to be feasible, safe and effica cious in the treatment of haemophilic arthropathy in paediatric patients wh o have been followed for a median of 40 months. As previously shown, MRI ap pears to give more detailed information about joint arthropathy than plain radiographs.